Reducing Amputations in People with Diabetes (RAPID): Evaluation of a New Care Pathway

Abstract

People with diabetes are at increased risk of foot ulcers, which, if left untreated, can lead to infection, gangrene, and subsequent amputation. Management by a multidisciplinary diabetes foot team has been shown to reduce amputation rates; however, accessing specialist treatment is made particularly difficult when living in remote and rural locations, such as many individuals cared for within NHS Highland. The RAPID project was made up of two phases: firstly, to evaluate the technical feasibility of a new integrated care pathway using innovative technology, and secondly, to establish process enhancement of the pathway to justify a larger-scale study. Omni-HubTM enabled a face-to-face consultation by the community podiatrist to be enhanced by virtual consultation with members of the multidisciplinary foot team, including specialist diabetes podiatrists and a diabetes consultant. The technical feasibility study provided recommended changes focused around adaptations to the equipment used and the best means to gain successful connectivity. The process enhancement study demonstrated positive outcomes in the process with positive effects both in the service received by patients and experiences of healthcare professionals involved. The RAPID project provides evidence and justification for a larger-scale empirical study to test an embedded pathway and technology solution, which will inform policy change and a paradigm shift in the management of foot ulceration in the community.

Bacteriological Profile of Diabetic Foot Infections and Its Effects on Limb Salvation

“…Aggressive treatment at initial stage, if not prevention can save the patient from this lifelong misery of losing a limb as described by Macruru et al, in 2018 and Welidi et al, in 2014 11,12 . Various studies in the past have conducted research on bacteriological profile among patients who have suffered from diabetic foot infections.…”

“…This correlational research was carried out at the surgical department of Pak Emirates Military Hospital Rawalpindi, from December 2018 to March 2019. We calculated our sample size by using WHO Sample Size Calculator by using population prevalence proportion of 85% 11 . Sampling technique was non probability consecutive sampling.…”

Gangrene in the PCP setting

“…Kod dijabetičara optimalna glikoregulacija predstavlja najbolji način prevencije ove teške komplikacije šećerne bolesti 12 . Srednji medicinski kadar ima značajnu ulogu u prosleđivanju informacija o promenama na koži pacijenata lekaru, pogotovu u ruralnim oblastima i okolnostima gde ordiniranje lekara nije svakodnevno 13,14 . Uvođenje savremenih obloga za debridman hronične rane, inicijalno alginata sa srebrom i poliuretanskih obloga u fazama zarastanja rane, sa oskudnom sekrecijom uz sistemsku i topikalnu antibiotsku empirijsku terapiju, najpre je dovelo do sprečavanja daljeg napredovanja gangrenoznog procesa i mogućeg razvoja sepse a potom i postizanja epitalizacije.…”

“…It`s especially important for the rural areas where very often the physicians are not attainable on a daily bases. 13,14 The introduction of the modern compresses for the debridement of the chronic wounds (alginate-argent ones at the beginning and polyurethane ones during the healing process) with the systemic and topical use of antibiotics stopped the further gangrene spread and eventually led to the wound healing. During the treatment, we also used the standard cotton gauze, but the possibility of continuous use of modern compresses and healing wound products could significantly speed up the healing process.…”

Technology‐enabled remote management of diabetes foot disease and potential for reduction in associated health costs: a pilot study

“…Building on our previously developed RAPID pathway (Fig. 1 ) to triage and manage diabetes foot ulceration in rural areas [ 4 ], we conducted a further pilot study that included an additional enhancement of the technology by incorporating ‘Direct Access’ software to enable remote access to clinical databases and a new video conference platform. We also developed an economic model to assess the potential value of the RAPID intervention project based on this pilot study.…”